How to Work Harder, Better, and Faster: Advice from a Paramedic

Key lessons on how to survive your 9-5 from someone who is switched on 12 hours a day.

Healthcare in the fast lane: rapid-response emergency medical care is a demanding environment. Paramedics need to be ready to jump at all times and deliver expert, life-saving assistance no matter how many hours they have been on the job.

“EMS is a different monster to your usual office job,” says Jason Holm, Branch Manager at ER24’s Cape Town South Metropole division. “ER24 paramedics work day or night shifts, for 12 hours at a time, on a rotational basis. One week it might be two days and two nights, with five days off. The next week we will work three days and two nights, with four days off. So, we’re looking at between 14 and 16 shifts each month.”

Add to those hours an unpredictable workload: working in emergency response means, literally, responding to emergencies, however, and wherever they arise. This kind of erratic daily work schedule can throw your body’s biological clock out of sync and increase your risk of developing serious health problems.

The everyday nature of EMS work means paramedics must work in opposition to their natural circadian rhythm. What might be exceptional for most of us is normal for a medic: they must be awake and attentive just as their circadian rhythms are pushing their bodies towards sleep, then find a way to fall asleep as their natural biological rhythm drives them to be alert. This leads to shortened and disrupted sleep patterns and can cause fatigue during working hours.

The dangers are a lot more real than simply feeling tired all the time. When fatigue kicks in, mistakes are made, and in EMS, that means lives could be lost.

So how they cope with it? Holm says eating properly and working on your fitness plays a part, but there is no replacement for regular rest and recuperation.

“We adjust our shifts to accommodate both the personal needs of our medics and the company’s key objectives,” he says. “I find that the guys working with me right now prefer working harder, for slightly longer, and then having a longer than usual rest period where they are able to recoup. They usually come back very refreshed. We do see some fatigue, of course, especially on the night shifts, but we keep more vehicles and other teams around during the day, so we can deploy them if necessary and split up the workload. We really guard against overwork.”

The temptation might be to charge right through a shift on nothing but caffeine and sugary sweets, but Holm says it is a priority for his team that the medics use quiet moments wisely. “No one sleeps during a shift, of course,” he explains, “but they should be sleeping properly before and after shifts. And even though it can get pretty busy – guys are in and out the door all the time – there are moments where they can have a seat, eat something, and think about something else.”

Regular breaks away from work-focused tasks can be a lifesaver, for both paramedics and their patients. “I’ll find them playing cards, chatting, laughing – they are very good at finding time to take their minds off what they see and do on the road.”

Regular sleep is essential to good overall health, says Dr Kevin Rosman, who runs the Sleep Clinic at Mediclinic Morningside. “Sleep controls numerous body functions including your hormones, bone growth, mood, memory, immunity, tissue repair, and more. If you look at the electrical activity in the brain while we sleep, in some ways, and at some stages, it may be even more active than during our waking hours.”

A landmark 2017 study found that disrupted circadian rhythms may lead to a range of chronic disorders, including Alzheimer’s, depression, worsened attention-deficit/hyperactivity disorder (ADHD) symptoms, heart disease, obesity and even diabetes.

Holm is dedicated to protecting the wellbeing of his medics. “If one of my medics is having a tough time or needs help, they will approach me for counselling, and we have specialists they can see to debrief. Sometimes they might work too much without taking leave, and I’ll see them begin to burn out a bit. At that point, I’ll step in and insist they take leave and get some time off the road.”